Are we flatfooted in our investigation of acute foot injuries?

Abstract

Abstracts / Injury Extra 42 (2011) 95-169 Results: 88 patients were trialled between May 2007 and April 2010. 80% (n = 70) of patients were successfully treated as day cases, 17% (n = 15) were discharged on the day of operation but required hospital beds for out-of-hours management and 3% (n = 3) required overnight admission. 58% (n = 51) of patients were successfully contacted within a week of operation. 94% (n = 48) achieved good postoperative pain control, experiencing no or mild pain only. 2% (n = 1) experienced other post-operative symptoms, such as nausea.100% of patients were satisfied with their treatment. 100% of patients were happy their procedure was completed as a day case.Conclusion: ACL tears are common traumatic injuries. We conclude that the significant majority of ACL reconstructions can successfully be completed as a day case procedures, reducing the need for hospital.Objective: To assess the usefulness of radiographs alone to evaluate acute midfoot/forefoot injuries. We believe that foot injuries are often under-estimated and that CT scans should be routinely obtained to aid in their management and avoid additional morbidity for patients.Materials and methods: In 26 months, 255 patients had foot injuries requiring X-rays. Of these patients, 94 (37%) had primary radiographs indicating midfoot or forefoot fractures, and 28 had subsequent CT scans. Radiographs were retrospectively reevaluated with respect to fracture location, type, mechanism of injury and then compared with CT results.Results: Of 255 patients, 213 (84%) had one or more fractures in their foot. A total of 397 fractures were seen with 105 patients having Os Calcis (41%) fractures. 94 patients (37%) had midfoot/forefoot fractures which included the 28 patients with subsequent CT scans. 56 patients (22%) had no injury. Of those patients with midfoot/forefoot injuries, 61 fractures were seen on plain radiographs and an additional 74 were identified on CT scanning.The major mechanism of injury in these patients was Road Traffic Accident (26 patients [28%]). Commonly missed individual fractures on plain radiography were Metatarsal (29), Cuboid (12) and Cuneiform fractures (11). Nine of the 29 (31%) metatarsal bone fractures involved missed fracture-dislocations of the Lisfranc joint. Other new fractures included Talus (4), Navicular (3), Os Calcis (2) and Tibia (2). 48 required operative fixation, including 20 patients that underwent CT scanning.We found that the sensitivity of radiographs in detection of midfoot fractures was low at 44%, and only 50% in forefoot injuries.Conclusion: In patients with high energy foot injury, and those with suspected complex injury, the sensitivity of radiography is only moderate at best. We suggest that CT scanning as the primary imaging modality would lead to a decrease in their morbidity.